Pre-exposure prophylaxis for HIV infection: what if it works?
Pre-exposure prophylaxis for HIV infection: what if it works?
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DOI：
10.1016/s0140-6736(07)61053-8
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发表时间：
2007-07-07
期刊：
影响因子：
168.9
通讯作者：
Jaffe, Harold W.
中科院分区：
文献类型：
--
作者：
Paxton, Lynn A.;Hope, Tony;Jaffe, Harold W.
尽管艾滋病毒感染的治疗取得了所有进展，但预防的主要内容几乎没有改变：性禁欲、避孕套、无菌注射设备、避免高危行为、了解自己的血清状况以及任何性伴侣或注射毒品的伴侣的血清状况。虽然这些战略可能是有效的，而且近年来一些国家和一些风险群体的新感染病例有所减少，但每天11000例新感染病例充分证明需要采取更多的预防方法。1关于成功的艾滋病毒预防技术的证据喜忧参半。南非、肯尼亚和乌干达的男性包皮环切术的随机研究很早就停止了，因为中期审查显示，与未接受包皮环切术的男性相比，接受包皮环切术的男性新感染艾滋病毒的人数减少了60%到74%。2-4几种局部杀微生物剂正在进行高级试验。然而，C-31G(最初由Celley制药公司开发)和纤维素硫酸盐(Polydex制药公司，巴哈马拿骚)的第三阶段试验提前终止，因为初步结果表明没有疗效(C-31G)5或增加了艾滋病毒传播的风险(纤维素硫酸盐)。6尽管AIDSVAX(VaxGen，加利福尼亚州旧金山南部，美国)的两项已完成的试验显示没有效果，但艾滋病毒疫苗的研究仍在继续。目前任何杀微生物剂或候选疫苗的有效性证明都需要几年时间才能证明，第一批产品可能只会有适度的效果。需要大量生产这种产品，并在世界各地分销，这将带来额外的挑战。9、10
For all the advances in treatment of HIV infection, the mainstays of prevention have changed little: sexual abstinence, condoms, sterile injection equipment, avoidance of high-risk behaviours, and knowing one’s own serostatus and that of any sexual or drug-injecting partners. Although these strategies can be effective and recent years have seen decreases in new infections in some countries and in some risk groups, the 11 000 new infections daily is ample testament that additional methods of prevention are needed. 1 Evidence for successful HIV-prevention technologies is mixed. Randomised studies of male circumcision in South Africa, Kenya, and Uganda were discontinued early after interim review showed reductions in new HIV infections ranging from 60% to 74% in the circumcised men compared with those who were not circumcised. 2–4 Several topical microbicides are in advanced trials. However, phase III trials of C-31G (originally developed by Cellegy Pharmaceuticals) and cellulose sulphate (Polydex Pharmaceuticals, Nassau, Bahamas) were terminated early because preliminary results suggested no efficacy (C-31G) 5 or increased risk of HIV transmission (cellulose sulphate). 6 HIV-vaccine research continues despite two completed trials of AidsVax (VaxGen, South San Francisco, CA, USA) that showed no efficacy. 7, 8 Proof of efficacy of any present microbicide or vaccine candidate is several years away, and first products will probably be only moderately effective. The need to manufacture such a product in large quantities and distribute it around the world will pose additional challenges. 9, 10